Motor Learning Theory

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,

based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

MOTOR LEARNING THEORY

References: Cole & Tufano, Chapter 19

Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT



Focus

• Replaces Motor Control (NDT, etc.) as a more evidence-based approach to all forms of movement disorders across the lifespan (CP, TBI, CVA, etc.)

• Backdrop for Task Oriented approach defined by Horak (1991), Shumway-Cook & Woolacott (2001) and Mathiowetz, Bass Haugen & Flinn (in Trombly & Radomsky, 2002).



Basic Assumptions

• Motor Control – the ability to regulate or direct the mechanisms essential to movement (Shumway-Cook & Woolacott, 2001). AKA “neuromaturational” or “hierarchical” or “bottom up” theories of re-acquisition of voluntary movement

• Motor learning – Set of processes associated with practice or experience leading to relatively permanent changes in the capacity for producing skilled action (Shumway-Cook & Woollacott, 2001). Combines neuroscience with systems & learning theory.



Assumptions, cont. • Based in principle of neural plasticity – the ability

of the nervous system to modify neural

connections to perform more efficiently

• Short term (working memory) – needed for

learning new movements

• Long term (save/retrieve) – needed for lasting

change

• Motor learning occurs naturally during task

performance (supports a task focused approach)



Systems Theory

• Systems approach includes a consideration of – Client factors: health condition, dysfunction or

damage, age, gender, etc.

– Occupations: meaningful or preferred tasks

– Environment: all relevant contexts

• Systems include sensorimotor, psychosocial, cognitive, and performance contexts (physical, socioeconomic & cultural characteristics of the task itself and the broader environment) (Mathiowetz & Bass Haugen, 1994).

• Consistent with occupation-based models



Learning Theory

(Behavior Modification)

• Non-Associative Learning:

– Habituation: desensitization that results from

repeated exposure to a nonpainful stimulus

(e.g., Ignore stimuli that trigger nonfunctional

responses)

– Sensitization: increased responsiveness (e.g.,

Pay attention to safety features, such as water

on the floor, or obstacles in one’s path)



Learning, cont.

• Associative Learning:

– Classical & operant conditioning (considers past and current environmental influences)

– Procedural learning: performed without conscious attention (develops slowly through many repetitions to become habitual, stored in brain as “movement schema”) (e.g., walking)

– Declarative learning: results in knowledge that can be consciously recalled, requiring awareness, attention, and reflection (e.g., words)



Learning, cont.

• Variable practice, using motor/perceptual skills under varying conditions, works best for generalization of learning

• Contextual interference, using motor perceptual skills in random order, increases spontaneous use for new tasks

• Individual characteristics, such as level or experience & intellectual ability influences motor learning

• Transfer of learning occurs more easily when tasks are similar (Toglia – near transfers)



Learning, cont.

• Schmidt’s “schema theory” uses sets of general

rules that apply in variety of contexts

• Schema: a generalized motor program that

consists of 4 parts:

– Initial situation

– Parameters used

– Outcome (knowledge of result)

– Sensory consequence (how movement feels)

• Example: swinging a golf club or donning a coat



Learning, cont.

• Newell’s Ecological Theory clarifies the

role of perceptions in motor learning.

– Recognition of goal or task

– Regulatory cues (sensitize to what is relevant

to the task)

– Knowledge of Performance (KP): feedback

during performance, how movement felt

– Knowledge of Result (KR): feedback on goal

achievement



FUNCTION & DYSFUNCTION

• Gentile (1992): early & late stages of

learning

• Fitts & Posner (1967):

– Cognitive stage of motor learning

(understanding of task, experimentation)

– Associative stage: refined practice

– Autonomous stage: skill relatively automatic

– Example: child learning to climb stairs



Function cont.

• Degrees of freedom: refers to gradual increase

in smoothness of performance of skilled

movement. Example: using a hammer.

• Specific definitions for function & dysfunction

have not been defined in occupational therapy

(Kaplan & Bedell, 1999).

• Definition of dysfunction in OT must include all

three components: person, environment, &

occupation.



CHANGE & MOTIVATION

• Holistic approach: OT ALWAYS incorporates practice of perception and movement within the context of SPECIFIC TASKS.

• Client centered: Motivation comes naturally when clients and/or families set priorities for tasks to be accomplished & goals to be achieved.

• Systems approach begins with role performance, considering the best combination of remediation, adaptation, & compensation in order to promote client-identified level of functioning to fulfill desired roles.



Change, cont.

• Change occurs through learning process.

• Recovery may be:

– Spontaneous, without benefit of intervention

– Forced recovery, function gained through

therapeutic intervention, such as – example?

– Adapted or functional recovery, attained

through altering methods or contexts within

which client accomplishes a task



Postulates of Change, cont.

• Defined in Pediatrics by Kaplan & Bedell.

Motor skills more likely to improve when:

– Match between child’s ability, task, & context.

– Child understands expectation & receives

clear guidance

– Independent problem-solving encouraged

– Just right challenge (zone of proximal

development).



Assessment

OT Assessment includes:

• Dynamic evaluation, watching client during

occupational performance, including

responses to cues.

• Collaboration with client to determine

occupational problems and priorities.

• Evaluation of person, task, & context, to

determine appropriate OT interventions.



Assessment • OT evaluations may incorporate manual muscle

tests, range of motion, strength & endurance

tests, which directly relate to problems with

specific task performance.

• Sensory & perceptual evaluations stem from

client-identified problems with those aspects of

task performance.

• Cognitive evaluations may further clarify

difficulties with awareness, goal identification,

motor planning, and generalization of learning.



INTERVENTION

• Client-centered role/task selection

• Discussion of OT assessment results

• Collaboration which includes therapeutic

use of self in determining and/or raising

level of client self-awareness

• Imparting information on current evidence

with regard to a choice of approaches

• Practice of needed skills in natural settings



Motor Learning Interventions

• Prevention of injury/dysfunction through

splinting, positioning, educating, &

sensitization to relevant environmental

cues.

• Promoting function through individualized

task problem-solving & collaborative

experimentation about the best way to

accomplish the task.



Interventions, cont.

• Practicing whole tasks, not isolated parts.

• Providing skill practice in varied contexts during daily routines.

• Providing randomized practice (changing parameters or circumstances).

• Providing intermittent feedback during task performance or summarized at end.

• Encouraging self-evaluation & error detection (both KP & KR).



Interventions, cont.

• Modify task demand in order to achieve

task goal (use e-mail instead of telephone

to communicate with others; use alarm to

remember next step).

• Modify contextual factors in order to

achieve task goal (use bolsters to position

for active movement in playing a game).



Intervention: Constraint-Induced

Movement Therapy • Contemporary variation of task-focused approach

for stroke survivors (1 year post-stroke).

• Consists of “constraining” nonaffected arm, forcing use of affected limb for performing daily tasks.

• In 2-week experiment, “constrained” group showed significantly greater motor skills, carry over to life tasks, and maintenance of gains in 2-year follow-up.

• Original study replicated (Blanton & Wolf, 1999) shows that 20% to 25% of clients with chronic stroke symptoms may benefit from this approach.



The End

• Please make your own copy of reserve

article. Focus on distinctions made

between traditional & contemporary OT

approaches.

Documents

Motor Learning Theory